The human and economic tool of osteoporotic fractures is staggering. Individuals who have had prior fractures are at increased risk of future fractures. Evidence-based clinical practice guidelines and effective treatment are readily available but incompletely utilized in this high-risk group. This is a retrospective cohort study designed to evaluate the treatment gap in older women who have had fracture associated with osteoporosis, to provide the foundation for designing in future secondary prevention programs for re-fracture. The treatment gap, as defined for this study, is that a woman does not receive pharmacologic treatment for osteoporosis. The gap may be due to clinicians not following guidelines if she either goes untreated without BMD screening, or does not receive a BMD screening and appropriate subsequent treatment, within six months of the index fracture. Or the gap may be due to the lack of patient compliance if treatment is offered but not used. The primary aims are to determine if woman aged 50-89 years with a prior study-eligible clinical fracture 1) the fraction of women with an osteoporosis treatment gap, and what fraction of the gap is due to clinicians not following the guidelines and what is fraction is due to the lack of patient compliance; 2) the distribution of treatment duration and the distribution of patient compliance; and 3) which patient, health care provider, and health care benefit characteristics available in our electronic databases are significantly associated with treatment gaps. The primary outcomes are: 1) provider initiation of treatment, whether or not within 6 months after the index fracture a pharmacologic agent for osteoporosis is dispensed, or BMD by dual x-ray absorptiometry (DXA) screening is completed followed by treatment for a femoral neck T-score at or below -2.5; and 2) for patient compliance with treatment, the percent of time after the index fracture the dispensed medication is taken. This proposal is significant because we will be able to longitudinally evaluate a large dataset of women who have had any index fractures associated with osteoporosis using clinical database. Through our extensive integrated systems we can investigate a broad range of factors for associations with osteoporosis screening, treatment, and compliance with treatment.